Emergency Medicine Physicians Accurately Select Acute Stroke Patients for Tissue-Type Plasminogen Activator Treatment Using a Checklist

What the fuck did you do with those that failed the checklist? It is still your responsibility to get them 100% recovered.  This checklist use assumes that IT IS YOUR RESPOSIBILITY to have the correct external signs of a stroke. Hope your know that before you get to the ER.  60 patients are not enough to validate this, I don't know what is but that is why you employ a statistician. 

Why would you do a checklist at all when these extremely fast diagnosis options are available? 

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes

Emergency Medicine Physicians Accurately Select Acute Stroke Patients for Tissue-Type Plasminogen Activator Treatment Using a Checklist

Ketevan Berekashvili

,

Alicia M. Zha

,

Mohammed Abdel-Al

,

Xu Zhang

,

Jazba H. Soomro

,

Samuel J. Prater

,

James C. Grotta

Originally published27 Nov 2019https://doi.org/10.1161/STROKEAHA.119.026948Stroke. ;0:STROKEAHA.119.026948

Abstract

Background and Purpose—

There is uncertainty among many emergency medicine physicians about the decision to give intravenous tPA (tissue-type plasminogen activator), which limits its use. A checklist approach has been suggested as a solution. We compared agreement on tPA treatment in suspected acute ischemic stroke patients between emergency medicine residents (EMRs) using a checklist and vascular neurology fellows (VNFs).

Methods—

Every suspected acute stroke patient brought to our comprehensive stroke center emergency room within 4.5 hours from symptom onset was prospectively evaluated simultaneously and independently by VNFs and EMRs. The latter used a tPA screening checklist, which included guideline exclusion criteria to help with their treatment decision. Agreement was determined using kappa (k) statistics.

Results—

Over 6 months, 60 patients were enrolled; 10% large vessel atherosclerosis, 18% cardioembolism, 12% small vessel, 12% cryptogenic, and 47% mimic. Forty-two percent were deemed tPA eligible by the EMR, 30% by the VNF, and 37% by the vascular neurology faculty. There were no complications in any tPA-treated patients(But did ANY of then get 100% RECOVERED? If not them your treatment failed.). Agreement was substantial between EMR and VNF (κ=0.68 [95% CI, 0.49–0.87]) and between EMR and vascular neurology faculty (κ=0.69 [95% CI, 0.50–0.87]). Stroke mimics were the main cause of disagreement between EMR and VNF (κ=0.24 [95% CI, −0.15 to 0.63]) and between EMR and vascular neurology faculty (κ=0.35 [95% CI, −0.08 to 0.78]).

Conclusions—

Our data suggest that with the aid of a checklist,(How fast is it? Faster than 90 seconds?) EMRs can accurately treat stroke patients with tPA. Areas for improvement include recognition of stroke mimics. Further studies are warranted to evaluate checklist-enhanced tPA treatment to allay emergency medicine physician uncertainty and expand the use of tPA.

Footnotes

The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.119.026948.

Correspondence to Ketevan Berekashvili, MD, Department of Neurology, NYU Langone Health–Brooklyn, 150 55th St, 3667, Brooklyn, NY 11220. Email ketevan.berekashvili@nyulangone.org